family health history focus group transcription

Librarian Focus Group Meeting 8/28/12 1

Librarian Focus Group Meeting – 8/28/12

Transcribed by Kristen Hanich, Project Coordinator

Moderated by Paula Winkler, Director of the South Central AHEC

Paula: Introduction…

Question 1. [0:00]

Paula: Are you more likely to be asked a more general question, like “how can I learn more about the topic?” Or a more specific question, like, “where is this book?”

1: I get asked both. I think I sometimes get a bit more of when someone has a particular title in mind, but often they don’t have the right title name.

2: Are we speaking in generic terms, or health questions specifically?

Paula: General. Just very generic, general terms. Just about your experiences at a reference desk, or just in the library.

2: I would actually say more general, then.

3: The same: general. Though, I will have individuals who say: “where are your medical books?” Or will say “I’m looking for a book about diabetes, because I’ve just been diagnosed.” You’ll have to talk them through to narrow it down for them, you know. “Where are your legal books?” They want a specific case about something: some constitutional amendment, some rule from way back. It always starts off as very, very general. Usually.

4: I would say both. Yeah, I think we have people with more specific questions and people with more general questions and it just depends.

Question 2. [1:37]

Paula: Are you more likely to be asked questions in English? Or Spanish?

1: More likely in English. But we have a lot of Spanish speakers, so we do get those. The majority are in English.

2: Much more likely in English.

3: Same. Though, I think we do have a Spanish-speaking segment.

4: More in English. But we do have a large Spanish-speaking community, so we do get quite a few questions in Spanish.

Question 3. [2:08]


Paula: So, do patrons at your branch tend to prefer print or electronic resources? And thinking about that, does a certain group or demographic usually prefer print to electronic? Or vice versa? Does that make sense?

1: I think I get asked more for print regardless of the demographic, but with younger patrons I think they’d be comfortable with electronic. But they often mention that their schools, it’s for an assignment. And for some reason they’re under the impression that their teacher will not accept an electronic document. So we have to, once we make clear to them that it’s not a random source; that it’s a vetted source, they’re comfortable with it. But, a lot of the older generation, uh patrons, seem to prefer it in print.

2: I think it really depends on the question. Because I think a lot of people… I know I specifically have a reputation for being good with ebooks, and so a lot of people get sent here, and so they think downtown is the place to go if you’re wanting whatever. More in-depth health or something. So we get a lot of older people wanting to come downtown here. We have one-on-one ebook assistance and things like that. We get a lot more questions about print, I think, people do prefer print. But here we get a whole lot of questions about electronic resources, and for us it tends to be older folks. Because they’re wanting more in-depth health and I think a lot of people think that downtown provides more in-depth health, and so they come down here for that.

Paula: So you’d still go with…?

2: I think they would prefer print, but we do get quite a bit of older folks coming in to learn about electronic resources.

3: I would say print as well. The individual really just wants their information and they’re not as comfortable with the electronic. They don’t mind it if you’re assisting them personally, as long as you’re with them, walking them through, they’re okay with that. More than likely they want to hold the print.

4: I would also say print. But if you do suggest an electronic resource to them, a lot of times they’re willing to take it if there isn’t anything else available. Especially if it comes to study guides that are maybe out of print or aren’t available, a lot of times they’ll be willing to take an electronic resource in its place.

1: One thing? Another part of what I think, sometimes, to access our electronic resources if they want to take it with them they have to print it out, and that involves money; you know – cost.

Paula: Would you say that that becomes a hardship for them? If it’s a lot. If it’s a lot, would it be a hardship?

3: It can, become a hardship.

Paula: But if it’s just one or two pages, is it still an issue?

3: They don’t mind. At least in my experience.


2: I get a lot of “oh, I don’t want to pay for anything, just find me a book.” I’ve gotten that lots of times: just a total block, like “I don’t even want to hear about your online stuff, or looking something up – just give me a book.”

4: I think if it’s a short, couple of pages, and I know that we don’t have something for them in the library, a lot of times I’ll just print it for them. Because I feel that what we don’t have, we can still provide. They’ll just read. You know, we’ll print them and stuff. We’ll do it for them, if we don’t have it in the library. It’s easier to do if it’s one or two pages: if it were ten, then I might say “maybe not.” But if it’s a short document it’s a lot easier to print it out.

Paula: From a manager’s point of view, obviously, it’s the resource of the paper, ink and things like that. Right? So, from a budgetary point of view you gotta keep that money.

2: I’ve instructed my people the same thing and if it’s something we don’t have and if we’d be willing to write it out given the time, “go ahead and print it for free” is the way I say it.

Question 4. [7:24]

Paula: Well, that brings up an interesting point. I’m looking forward to hearing your answers on this one. Do you refer any of your patrons to your LibGuides? If so, do you think they find them useful? And do they use them on their own?

1: I’ve very rarely had a person who needed to do that. So, I would say “no.” And I don’t think they use them on their own.

2: I do. I don’t necessarily refer patrons to a LibGuide. I use it myself. My library creates a whole lot of LibGuides. We’re downtown, and that’s kinda one of our calls. I’ve got a medical, uh, librarian who’s a medical expert, and when she’s not around and someone’s got a medical question I’ll head to the LibGuide to see which resources she finds most authoritative and so it’s not necessarily something I say “hey, go home and check our LibGuide,” but I use to, kind of, get her expertise. I have a few LibGuides that patrons do find on their own – I know because they email me; there’s an email form on that. The ones that I have that patrons are finding are all hobby oriented: crochet, knitting, things like that. So I get a lot of emails about knitting groups. But I think I have one or two that are non-fiction based and have never had a patron question coming in from there.

3: I’d say the same thing. I’ve rarely had the opportunity to offer them as a resource. Most of the times I’ll use it as a training tool for myself, so that I can find the information that may be a little more authoritative but that I may not know as much about. But for the public, no, not really.

4: I don’t think I’ve ever suggested one. I know it contains valuable information that, if someone had the time, and the interest, then I would point it to them but it isn’t often that someone really is doing research. It’s usually that they just want a book, or they want a website, and they really don’t want a LibGuide or to go digging through different resources. But if I did encounter someone that had an interest and had wanted to do research, then I think a LibGuide would be something that I could point them to.


3: Our patrons really aren’t interested in learning the process of getting to that. They just want that information.

Paula: And that’s the other question. Is it so new that it’s just going to take a while to catch on?

2: I think we’re just not [pause.] We don’t know the purpose just yet. And it’s funny that you guys are asking this question, because one of my department’s goals for next year is to take a big picture view of LibGuides and say, if [1] has an interest in something he can take a look at it and that’s it. There’s no collection or policies about the content of what’s on there and no big picture view, so that’s something that we’re going to be looking at for next year. But it’s not new, we’ve had it for a few years now already. I think we just aren’t sure what the purpose is in a public library. It’s very heavily used in our downtown libraries. Not a lot of libraries use them as much as we do. We have hundreds of guides.

4: I think it’s good for librarians to make as they become an expert in that subject and if they ever get a question on it they know where to find more information or they can refer other librarians to the LibGuide to find the information. They might make it available to the public even if it’s not going to be used very often, it might be a good idea to just have it on them.

Question 5. [11:30]

Paula: So, if and when patrons ask the more “general” questions at the reference desk, what is your approach? Do you try to answer their every question, or do you find just enough information to let patrons continue the research on their own? What factors come into this and affect it, basically? Is it time, understanding of the topic, those kinds of things?

1: I always try to make sure that the patron feels that I’ve satisfied their need. It really depends on the context: some people have more complicated needs, some people are just like, reference; “where is the capitol of Hungary?” you know.

But other people who are doing research on topics, because it’s clear that they have a paper they have to write, you know, I use the opportunity for them, to teach them about the process they’re going to go through to do that. So there might not be one book that’s called “The Causes of the Mexican-American War,” you might need to look at different books and I can show them how to use the index and find relevant sections to skim through: you don’t need to read the whole book.

And once I feel that they have a game plan, that they can say: “oh, you know, this is how you go from here to there,” well, there you go. And, time definitely comes into play. It depends what time of day it is. Are we about to close? I let them know what I can do in a reasonable amount of time. I let them know about our hours, I let them know about other branches that may be open later, that we can sort of “hand off” the thing, “hand off” assistance to.

2: I think it also depends on the sensitivity of the topic, and maybe the psychological factors surrounding it. The body language can kind of tell you how comfortable they are when they’re coming to you. You know, if they’re not meeting your gaze, and they’re looking down and they’re saying, “I need something on cancer,” you know you need to be extra sensitive with how you approach that reference interview.


And there are some ways where you can respect their privacy when you do that: you can lead them over to a catalog where you can show them how to do some other in-depth searching and check on them a few times and sometimes they will engage you and help you in that reference interview, get what they need. But I think sensitivity and body language are very important as well, especially when you’re talking about health topics. [mumbled] It’s like that for every question [?]

?: Every question?

2: Well, absolutely, it depends, but I always check back with them. You know, even if I’m sending them off to another floor. If it was a very sensitive topic I might call upstairs and say, “you know, I have a gentleman I just sent to the 615s, would you go check on him in a bit? Make sure he found what he needed? Because whenever it’s an issue where they really, you know, it’s more than just a book on water colors. You do need to make sure that they’re comfortable, I think.

3: It’s the same thing. It really depends on their demeanor, the complexity of the question, whether they’re an older individual. I think it really just depends. And you cater your approach to that specific individual at that time. There’s some individuals who want you to give them everything you can possibly find on something, and there’s some that just want enough because now they’re on their own, they like exploring on their own. For those individuals I might just come back and say “are you doing okay?” and if they need anything else they’ll direct me from there. “I need another reference, this wasn’t exactly it,” “then let’s see if we can find something else.” But it’s sort of circling back, to, as [2] does, to see if they’re okay. But it really depends on so many factors, including how busy we are, how many people we have in house, and you sort of develop, quickly, what that particular patron needs, and you hope that they get what they want.

4: Yeah, I think it depends on the comfort level of the patron. How comfortable they feel discussing the topic with you. I find that sometimes if I walk them over to the section and start showing some books to them , sometimes they’ll open up and say, “that’s not what I need, I’m looking for this.” So, just trying to have a little bit of patience, leave them to kind of explore, and always coming back and asking them if they found what they were looking for. It seems to help.

Question 6. [16:30]

Paula: Okay, so those were the end section of the general reference questions and we’re going to have more of the health-related. So, we’re going to change the answering process. We’ll start with number 4 and come back this way [gestures.] In your own reference experience, about how often do you receive health-related questions? Daily? Weekly? Monthly?

4: I would say probably weekly. Rarely daily. Sometimes monthly. So, not very often.

3: I’d say weekly as well. And then we’re – since as branch managers we may not be on the floor as often as other staff members, who are fielding them a little more often than we are. But at least weekly, I would say weekly.


2: Well, here downtown we definitely get it daily. I know that we’re around a lot of hospitals and people will sometimes come right from an appointment and straight here. And also a lot of people may skip their community library – assuming they’re all about story time or they’re all about local needs - and they come here thinking this is a more rich environment for research, or nonfiction. Definitely daily here.

1: I would say weekly. And even then, sometimes, I think I’m more likely to see someone at a table reading a health book, [pause] and then having approached me.

Paula: So they found it on their own?

1: Yeah.

2: Yeah.

3: Yeah.

Question 7. [18:16]

Paula: Okay, so who tends to ask you for health information? Is it men, women, teenagers, senior citizens, parents, grandparents, all of the above? And do these demographics change seasonally? You know, when they’ve started school; are you seeing any differences from the summer into the fall? Do you get a sharp increase of teens asking about information around the time that school projects are due, or tend to be due? You know, those kind of things. Kind of a lot of questions in one.

4: I would say it tends to be middle-aged to older individuals, mostly women. I don’t really notice if it’s seasonally, I don’t think that’s a factor. We do have younger women asking a lot about pregnancy. You know, books on pregnancy. That’s kind of a common question that I think most libraries get. But yeah, I would say that the majority of the questions come from older individuals.

3: I’d say exactly the same. I’d say middle-aged or older women who are either inquiring about themselves or about a family member and the other, that is to say, younger women, who are looking for materials on pregnancy. Primarily women, yeah.

2: We tend to a lot. We get some people who come in, maybe baby boomers, asking about elder care. So, information about maybe their parents. We also get, certainly, some seniors coming in about themselves as well. We don’t get a lot of younger folks coming in here, either. It’s mostly boomers or older. And really, when it’s a baby boomer, they seem to always be asking about their parents. Seasonal changes? Well, we do get some folks coming in, you know, kids will come and they’ll ask about STDs or abortion and you approach it very sensitively and it turns out to be a school paper or project, that kind of thing. But it’s not as much of an increase where it would affect traffic or anything like that. It’s rare: we can’t predict it.


1: Ditto what everyone else said. The only thing I want to add is that they, especially the middle-aged and older women, a lot of times – and this has happened with a couple of Spanish-speakers – they wanted to look for a, what do you call it, homeopathic or traditional remedies.

3: Yeah, those are very popular at [my branch] as well.

2: Yeah, here too. They get used in-house a lot. Get worn out very quickly.

Question 8. [21:30]

Paula: So, what language do patrons tend to want health information in; when they do ask for health information, what language are they using?

4: Well, sort of like the general question, most of the questions come to us in English but we may have a lot of Spanish speakers who want the books on health, the information, in Spanish.

3: The same. Exactly: the majority English, but we do have that smaller faction. We need just as valid information in Spanish.

2: I tend to hand off a lot of Spanish questions as I only speak barely decent Spanish, but I would say people want their health information in whatever language they’re most comfortable with. Mostly English, yeah.

1: Same. English predominantly, but a notable number of Spanish speakers.

Question 9. [22:32]

Paula: For the record, what are some of the health-related topics you get asked to research? Is it something like a process, like diabetes? Or is it a technical question regarding something like an MRI or a CAT scan? Or the side effects of a medication, or something like that?

4: We’ve never… I know we’ve had questions, I’ve taken questions on diabetes and on what diet they should have, what kind of foods they should eat. I’ve had that question several times, those books are really popular. Topics on arthritis, I’ve heard those a few times. Cancer, a couple of times. Pregnancy. Those are the primary questions that I can remember off the top of my head.

3: The same. Primarily diabetes. Diet as well, for managing. Heart health, as well. Recently, I’ve received a couple inquires on diet books. Her husband was diagnosed with a heart ailment that they weren’t sure about, so she wanted to be sure that they had the right type of foods for him, and things like that while they were still trying to figure it out. So, yeah, same. Along with what [4] said those are the ones that, primarily, we get questions about.

2: I feel like it’s flipped here. We tend to get a lot of cancer questions. We also have a telephone directory so we’ll get some in-depth questions over the phone. For those it’ll usually be quick questions, like: “what does this test mean?” or “I’ve got to go take this blood test.” So we do have some good test reference books and of course we’ll use the National Library of Medicine websites as well. I feel like


we’re kind of flipped. The really simple diet/diabetes questions, I think, people will rely on their community libraries for that and they might come here for maybe the more scary things that they feel they might need to do more research into. Do you all agree?

3: Maybe once in a while we’ll get a request from the PDR. “We just got medication, and we want to know…” [interruptions – 2 and 4 agreeing.]

1: A lot of those, again, are homeopathic stuff on remedies, family health, books. I’ve had a couple of people want to get information about certain diagnoses, like, bipolar. They want to look up certain drugs. To see what their side effects are, what they’re for. You know, mental health questions also do come up with bipolar or autism, schizophrenic, topics that are controversial, at times – in English and Spanish regarding autism.

Paula: They have more questions about autism?

3: They do.

2: When I worked at a smaller one, we had a lot about ADD and ADHD and those.

Question 10. [26:12]

Paula: So, have you ever had any formal training in searching for health information?

4: No.

3: No. A little training here or there, but no formal certificate ending, no.

2: No formal certificate, but I was part of a different grant that you guys had a few years ago. You worked with the [redacted] and trained us for it. So, yes-ish.

1: No. In library school you had to take the reference class and I think I vaguely remember their being a health component, but nothing specialized.

3: But we’re willing to do it.


Paula: Have you ever searched for health information online for yourself or your family? And do you think your experience searching for this information influences how you research or search for information for patrons.

4: Yes I’ve used online resources for health information for myself and my family. Yeah, I think anytime I’m doing an online search I think about how I might use that to help a patron try to find the best resource and evaluate it and think about ease of use – how easy it would be for a patron to use. So yeah, it definitely influences what I refer patrons to.


3: The same for me. I use it for personal and my family health as well. Yes, it makes us a little more efficient, when that patron comes in and you’re not starting from ground zero for them – you know what resources, you know how easy it is to navigate through to get the information for them as well. It sort of keeps you fresh.

2: Yeah, absolutely. I personally hate taking medicine. I use Medline, where they give grades to homeopathic remedies. Like, you know, the research says this is a “C” for curing diabetes, or whatever it is. So when people come up and they’re asking about homeopathic remedies I’ll find them the book that they’re looking for but I’ll also show them that. So, I use it for myself and that does impact how I help patrons with it as well.

1: Yeah, I’ve done it for myself and my kids. And it depends, I’ve used Medline and I’ve used stuff on WebMD and I’ve used MayoClinic. And I remember, going through there, sites that looked, as [4] said, very simple and easy to use and kind of a good reference for patrons if they just want one stop for their answers.


Paula: Okay, so do patrons asking health-related questions ever voice concerns over their privacy of the reference center? What steps do you take not to overstep their privacy? Do you have any formal training in privacy?

4: Not for medical, per se. Just general privacy rules that involve the guidelines. No one’s ever voiced a concern about privacy. But again, you try to feel out the patron, see how comfortable they are with sharing the information and let them know that you’re really not going to share the information with anyone else. But I think, trying to get that across while you’re helping the patron, just by the way you’re approaching things, the interaction that you’re having: not being loud, not saying “oh, so you have cancer!” or whatever. You say it quietly. Or, if it’s another question, sometimes you won’t be as quiet. I think you can sometimes sense what volumes comfortable and don’t go any louder.

Paula: So have you ever had any formal training?

4: No formal training, no.

3: No formal training. I think you really have to take the demeanor and the question into consideration and at times say: “well, let’s go look for those books there,” and part of it is removing them from the reference desk, where we may have other individuals who are in line waiting for assistance. So we try to remove them from that as well. Sometimes you they don’t think it’s as private as you think it should be, and so you try to remove them from those places as well so that you can continue a quiet, comfortable conversation with them. And then asking them; “is that what you’re looking for? Is that what you need?” and then feeling out that level; do they need more, are they done, do they prefer to be on their own?

2: Sometimes I wish they would want to be more private. But, no, I’ve never had anyone voice concerns. We may have people with mental illness who may be kind of above and beyond worried


about their privacy, and feel that we’re overstepping it when we’re not. We’ve actually in the past couple of years changed the way we do our new employee orientation, for all downtown staff and we do have an hour-long training in privacy and intellectual freedom is part of that. But really, it’s more about reader-privacy than about informational privacy. So, there’s some formal training on privacy as part of the new way we train, but not specific to health.

1: Same thing. No one’s ever expressed any concerns. Usually by the tone of their voice, their volume, they’re like cuing you to be more subtle, you know, but as long as you’re on the same wavelength. You might have to take them to the stacks or something to get a better sense of what their deal is, so that they feel it’s just a conversation between the two of us. And I don’t pry: I let them reveal however much information they feel comfortable and, you know, as [2] said sometimes you get too much information. But usually they don’t want to go over it too much. And, no, I haven’t had any formal training on how to handle that information. I understand it to be confidential, but I don’t know.

2: It’s kind of an ethic of our profession, as you all know.


Paula: Okay, so now we’re going to move into the more scientific approach to health records, especially as it relates to genetic-related conditions. And to that end, we’re going to switch the order again and we’ll start with number 3, and then number 2, and number 4, and number 1. Okay? Alright. So, to get the gist of this, everybody’s going to get a chance to go number 1. So, if someone were to ask you for information about what causes breast cancer, what print or electronic resource would you consult first?

3: I’d probably consult our catalog first, to see if we have something available for them in-house in case they want to get something right away. If we don’t have anything, say, a print material that they could take with them, then I’d go to MedlinePlus. I like that resource very much. If that doesn’t suffice, say we don’t have it, if MedlinePlus didn’t have it, we might go to Interlibrary Loan to see if there’s some materials. Especially if it becomes more research in nature and they’ve exhausted all of the general materials, we have the interlibrary loan as a possibility, to get some more materials from other systems as well, so we keep expanding on that. I think I would start with the catalog and then MedlinePlus, and then, depending on the need, research other ones. Because we have more research-based databases as well; and also, we have them in Spanish as well, depending on which one. MedlinePlus is great, because we have it in Spanish, as well.

2: Since it’s a pretty general question, I would have probably started with Medline, actually to see if there are any sources recommended on there. And then, depending on where their question is coming from, if it seems to be a personal question, or if it’s a research question. I think if it was a personal question I would want to head to the catalog to see what I could get them to take home. If it was more a research question, depending on age, I know Opposing Viewpoints is a database we have that gives overviews of topics and it’s, like, for if a high school student is doing a research project. So yeah, if it’s more research-oriented we head towards databases or maybe towards the stacks, but if it’s personal we probably just lead to the stacks.


4: I think similar to what [2] said, it depends if it’s personal or a research question. That would kind of guide you as to what resource you would use. All the same resources [3] used, or a catalog.

1: I’d look at whether it’s personal research, but I’d also look at how much information they need. My instinct is to go first with the electronic, only because I think it’s probably more current. And it would be shorter. And especially for causes, I don’t know how long that would be. But, depending on the patron, if they wanted something that’s more in-depth then I would guide them towards books and they could end up taking them. But if they just want causes, then I can get it from a database, find one to two pages, and say “does this fit your needs?” and if it doesn’t we go back and get a book.


Paula: So, if someone were to ask you for information about family health histories, what print or electronic resource would you consult first?

3: Family health histories? I haven’t had that question. Then I might start with MedlinePlus on that one. Just to start exploring, and just get a general feel. Probably that conversation would become more personal, “what type of information did you need?” and then what are they looking for at that point. That would be a little too general for me.

2: Yeah, I’ve never gotten that kind of question. I’ve just heard about this great resource on the Surgeon General’s website, though?

[laughter]

2: Actually, I might start in the catalog, because I know we have some family health guides. I don’t have any idea what’s in them; I’d probably check the index and see what’s in there – if not, then head on to some more resources. That’s odd that we’ve never had a question on that.

3: We would google it!

2: Yeah, google it!

[laughter]

4: I think that sometimes if you don’t have a really good sense of the question, you know, sometimes you can just go google the hits and use your own expertise at evaluating the resource. That’s helpful, to kind of get a background of what the topic is, and you can sort of go from there and see which resources are probably the most valuable to the patron. Google works.

1: Yeah, I know, I agree: it’s really such a broad topic and you’d really have to use all those strategies to kind of see what kinds of related topics you might have to sift through. I mean, yeah, because I can see like, family health history, first of all; how to do their family tree. You know, I have to go to the genealogy section, and if they’re interested in how balding is passed down they might want a couple articles on that. So, I guess you have to develop a different path depending on the specific health issue.



Paula: Okay, so now we’re going to move into health literacy in the public library. And we’re going to start with number 2, then with number 1, number 4, and then number 3. Okay? So, do you think your library is currently a health resource for your community? What health resources do you think are unique to your branch, or to the San Antonio Public Library as a whole?

2: Well, it’s funny you’re starting with me. Yeah, we’re definitely a health resource for the city and for the neighborhood. I think with a lot of the very common diseases people tend to go to the library in their community, and sometimes you think of certain things as a community. I think that, like, when you’re thinking of homeopathic remedies you might think of your community library but when you’re thinking of health research you may think “I’ve got to go downtown.” The resources that are unique to this branch are certainly our more in-depth reference resources – we’ve got a very large reference collection, we’ve got the AMA directory, so you can see what specialists there are and things like that. We do get questions about those, and we refer to our print reference resources. They’re not very common, but they come out. So yeah, we do have reference collections that are unique to here.

1: Yes, I think we’re a health resource, but I think we could do more. I think we could do a better job advertising ourself as a health resource. I think a number of people out there who might have those same questions might not consider that the library might be a good place to go. And I don’t even just mean patrons: I think of organizations – like you all, physicians, non-profit organizations – seeing us as a place to tap into the community, to be that link. To provide the public with the latest research, and to provide researchers with real-time information on the ground about what peoples’ concerns and needs are. And I think that’s what – in addition to our documents, our databases, and our books in terms of unique resources – I think our unique resources are our patrons.

4: I think we’re definitely a health resource for the patrons, just from the questions that we take on a regular basis. And people think of why they need information, maybe they’ve already left the doctor’s office and they don’t want to make a trip back, they don’t want to make an appointment – they just want more information, they just got a diagnosis so, you know, they want more information so they come to the library. So, they do look to the library to provide that information. I can’t think of any unique collections that we have – since we have a floating collection now, the books that we have in our collection can move to another branch: it’s not static. But I think in general a collection tends to look at more popular subjects like diabetes or obesity, you know, those topics. I think all the branches have a pretty good collection of those books.

3: Yes, I believe we are seen as a health resource for our community, but we’re not necessarily thought of, as [1] said, by the medical community in general or health-related organizations as a resource. So we don’t get those referrals by those types, say, a nurse in a physician’s office might say; “you were diagnosed with this, the library might be able to get more information for you.” That’s something that doesn’t happen; I think that’s something that needs to be done better. Somehow we need to get that word out; that we are there to be a resource. And what makes us unique is floating collections, I think, because if an individual is looking for a particular item it doesn’t necessarily have to be housed at [my]


library, it can come from Central as well. So that’s what makes us unique; the one patron at [my library] has access to all of the information available to them. But yeah, I’d like to see that more: health organizations and medical offices, the medical community in general, seeing us as a resource. I think that would help.

2: Yeah, there’s like one or two doctors in town that’ll give out a piece of paper and I remember that when I was working the desk a lot more someone came in with a piece of paper that was like, “counselor, marriage counselor,” who would come and I would immediately know what titles to start looking for. It was just the one guy who was doing it, but it would be great if more physicians would do that, yeah.

[sounds of agreement]

Paula: You’re giving me some good ideas, here.

[laughter]

Question 16 [45:55]

Paula: So, what do you think when you hear the phrase, “health literacy?”

2: Oh, it’s me first. I think it’s the ability to recognize source credibility, I guess? To recognize the credibility of the source of the information, and think strategically about how to incorporate that into your health.

1: I think it’s knowing how to find current, evidence-based, consumer health information. And that involves, again, knowing how to evaluate your sources. It’s not just how recent it is, but who’s providing that information, how did they get it?

2: What’s their bias?

1: Yeah. I mean, and sometimes the conclusions aren’t black or white and they’ll say, “in clinical trials, 80% of people that…” [trails off] So, they can have more realistic expectations as to what might happen if they choose a certain course of action when it comes to treatment, etcetera. They know what their options are.

4: I’d say the same thing. Just being able to evaluate the resources, and looking at who the author is for the study or the book or, you know, if it’s a credible source. Being able to kind of weight it against other sources.

3: We were all saying the same thing: health literacy is being aware of the health sources that are credible for the individual. Not a lot of our community has that: they don’t know where to go, or where to begin. Health literacy means being aware of the options that are available.


1: May I add one more thing? I see it as empowering the patrons, so that when they’re acting with their health provider it’s dialogue; it’s not a one-sided conversation. They’re well-informed enough that they know what questions to ask.


Paula: Okay, now. I was really wanting to get to this question. So what do you think is the public library’s role in fostering health literacy? Or, if it has one?

2: It’s to teach our users, at the same time as we’re helping them. It’s to reach out when, again, we have opportunities to work with outside organizations and things like that. Definitely user instruction on the front line is what is really the basic role of the public library. Fostering their own individual and independent use of information.

1: Very generally the role of libraries – not just when it comes to health, although we are talking about health – is to anticipate peoples’ needs, kind of see what the short-term, the long-term needs are. When it comes to health literacy, I think it’s our responsibility to become experts in finding this information, and I think it’s an area that we need to work on. Because if we’re going to help patrons to find that information we need to know how to do that as well, and it needs to become second-nature. I think we need to be pro-active; we shouldn’t just wait for the patron to come ask us a question – we need to have something that finds them. And then when it crosses their path it gets them to see how the library can help them, because I’m not sure they view the library playing that role. You can change their perception of how we can help them.

4: I think one of our roles is also to make sure we have good collections that are current, up to date, easy for patrons to use, and then showing them how to use those resources. Make sure that they have easy access to them – I think that’s really important, too. And also, as [1] was saying, that we’re trained to use those resources; both electronic and print, that we can easily point the patrons to those resources.

3: Well, along with all of that, continuing to promote health-related programming in our locations, so that individuals see that as a consistent within our facilities. I think that would go along with all of that.


Paula: So, we’re almost done. These were the last of the health-related questions. Did our discussion today trigger any thoughts that you wanted to bring up, but didn’t get a chance to?

1: I’ll have to dwell on it. Usually I’m sure I’ll say no now, and then when we close that door [trails off.]

[laughter]

1: I’ll chase you in the parking lot.

[laughter]


2: Well, I’ve been wondering if any of you guys have those health stations installed in your libraries.

[agreement]

2: I’m just curious how it coincided with the groups that [the AHEC] choose to reach out to.

1: Now that you bring it up, it makes me think of one of the criticisms I’ve heard. About how the public library’s health station was just there, and didn’t seem to be part of the library environment, it just seemed to be there. It wasn’t really incorporated into the library experience, so when patrons asked questions about the machine, staff seemed not to be able to answer those questions. Whatever we do, I just think it’s important that, um [trails off.]

Paula: Alright, so were you given an in-service, or anything on how to run the machines, or how they were done?

2: I was snooping around in a storage cage that we have one day, and I found this big pile of boxes and I opened it up, and it was the publicity material for all these health stations, and it has all these pathfinders and they have children’s activities on them. I’m like, “oh my gosh! So cool!” and I was going to the MetroHealth strategic plan thingiemcbobber, so I grabbed a bunch and I called up a person and I said, “hey, we need to send these out to the branches!” and she said, “put those back! They’re not all installed in the libraries, we’re not allowed to publicize it yet!” So, it’s kind of a shame that we can’t publicize it yet, because a couple of them haven’t been fully installed around town, but you’ve got people at [this one library] going, “what’s this big machine?”

[laughter]

1: I think we can show them, it’s not like we don’t know it’s there.

2: Yeah, I know.

1: It’s not like it just showed up one morning.

2: But it’s not part of a big push.

1: Right.

2: I think there’s one planned, but.

1: And even when they present it to us, it’s almost presented to the patrons as; it’s in the libraries, but it’s not our plan. You know, and I think it kind of sends a message that it’s not, um.

Paula: But it’s typical, it’s very typical.

1: But I think, just, being careful about doing too much top-down and making sure that you’ve got community buy-in and awareness built in. So there’s like a strategy; they’ve got phases of deployment and stuff.


3: We haven’t had any negative feedback about the station other than, “it’s not working right now!”

Paula: We’ve heard a lot of that on the MetroHealth side, from the physicians, specifically one that is running this project. He was saying he’s proud of the fact that they’re in libraries because he very much values that the library is a huge asset in the community, and he understands from our work and working with libraries and gathering information, using the library as a connector to the community, you know, is a huge asset for our projects. But it’s the mechanical issues, and he said that people are just not completing them, and we don’t know if it’s because we didn’t do it right as far as telling people how to work with it or they’re not completing it so we can gather the information. Because it is essentially a research project – that machine is a research project. And so I said, “so everyone is thinking they’re getting things in it,” and he said, “oh, my god, I hope not,” and I said, “well –“

3: Well, I think our community is actually used to it. That it’s there, it’s okay. Because they see it at Walmart, they see it at HEB, they see it at CVS. So, like, at that type of facility. So, no, I haven’t had any type of negative feedback, and they’re used daily. In fact I took a picture once, because the family was kind of standing around it, and they were taking their weight – everyone was taking their weight.

Paula: Well, it’s interesting though, because what’s happening is that that machine is registering that information and when it does register that information it puts it into a database. And it should, basically, give you some feedback as to the health initiatives, or the health issues, that are going on within the community that your library serves. Do you get that information?

2: Not that I’ve seen.

Paula: Yeah, so, there’s a lot of connectors that we still have to connect. That’s all a part of the principles of community-based participatory research. Everybody has got to be at the table, not just the investigators. Everybody, including you, who are the connector, has got to be at the table when all this is going on.

4: If I could just add one thing: I don’t have a machine at my location but I’ll be curious as to what sort of follow-up there was, what additional information, so if a patron got a reading that they were concerned about, is there a sign there that says, “ask your librarian about more information on this topic?” What’s the connection between the machine and the library? Other than it’s sitting in the public library.

Paula: And those are all very good questions. Again, you just brought up the whole point of the principles of community-based participatory research: it’s got to have a mechanism of being able to take it further. That’s why we don’t want to create this curriculum without your input. Saying, “well this will work.” But that really hasn’t happened here. It’s like putting brochures together that you can’t give out.


Paula: So I’d like to kinda conclude by getting your thoughts on library programming as a matter of fact. Since our project is taking place within your library, we want to make sure that we market and evaluate it in a way that makes sense for your respective locations, your individual neighborhoods, or, the


patrons in the community you serve. So, what do you find are the most effective ways to promote a new project or programming within your library? And we’ll just open this up to whoever wants to start.

1: Well we have this, what is it called, business decisions, is that it?

[noises of agreement]

1: So, in [my library] you can identify a geographic area and get demographic information, and they even divide the country into these profiles – they call them tapestries – segments, I think at [my library], I’m sure its similar at [other library], you have a lot of families that center on children and it says that the best way to reach them is through radio and TV, and that includes Spanish radio and TV. And that’s something that I’ve always wanted to do, be promoted through that channel. I haven’t been able to. I’ve relied on a lot of those free local papers, like the Southside Reporter, La Prensa, and just our own personal experience when we did that focus group, I just went directly to the schools – I chopped up six-hundred fliers and I went to all the elementary schools and gave one to every student.

Paula: And it worked, because we had people who showed up – I said, “well, how did you hear about this?” and they said, “well, my kid came home and in their backpack there was this thing that I, you know, just read.”

1: Well, again, I think it goes back to, because the community where I’m at it really centers on children. It’s not the parents taking care of the kids; it’s the grandparents taking care of the kids. And somehow, through the kids, we reach the parents. And obviously everybody shops at HEB, if there was a way to somehow reach them there I think that would have potential to, you know, go where people go.

4: I think it would be great if we could advertise our programs on radio and TV, but I think it’s the question of expense for the public and that’s a barrier. So, we don’t do it typically. But, that is, and I have the same tapestry, segment, as [1]. In the Southwest families listen to radio and TV and that’s where they get a lot of their information and I think they would be great resources. We’ve also gone right out to schools where we give them fliers and they’re given to the children and they give them to Mom and Dad, and that’s how they hear about some of our programs. I think the programs that are focused on the family as a group tend to do better than ones that are just focused on adults by themselves, so somehow incorporate the whole family into the program: have something for everyone to do, so that they don’t have to look for a babysitter, or so they feel like it’s a family outing. So they feel like it’s something to do on a weekend or even an evening. I think that could help it be successful.

3: It has to be inclusive of all generation levels, that one particular program. And, in fact, we had the YMCA who’s doing something like that for nutrition, and they will be teaching families nutrition and then they have activities that they’ll have the whole family do. They said that they might have those brightly colored umbrellas, they put a ball in the middle and the whole family does this. But they’ll also teach them that you can take an ordinary sheet from home and do the exact same thing. You don’t have to have anything specialized. So far we have two families that are registered to do that. And that was just with in-house advertising. So we’re slowly starting to build a group, and it’ll start maybe in September or so, we’ll see how that goes.


2: Well, here downtown we have the largest population of seniors in this area, a lot of senior centers around downtown. There’s also a whole lot of shelters around downtown. We recently hosted a six-week diabetes education seminar that went very well. But, very low income, very, uh, a senior population around here. Downtown recently started free parking on Tuesday evenings, so we’ve incorporated a lot of the programs that we think reach out to people to whom that’s very important. We’ve moved those to Tuesday evenings. And kind of our high profile events, oh, famous celebrities, coming out to do some PR or for a big quincinera fashion show or something like that, those big events, we’re moving to Tuesdays to attract more people. But really we’re hoping, those of us who actually do programming, are really hoping to reserve those Tuesdays for people who really need free parking. That’s our audience, our audience is a lot of seniors, a lot of folks in shelters. We do get some downtown, more urbanites, but it seems like every time I meet someone who’s, you know, young, and they live in a loft downtown, they’re like, “oh, I’ve been meaning to go to the library, but I never have.” We don’t get a lot.

Paula: It’s like living next door to Six Flags. Or Schlitterbahn.

[agreement and laughter]

2: I know a librarian – she now works at the National Library of Medicine – she lived at the lofts that are literally a block away. She lived there for years, never made it to the library. I’m like, “come on, you’re a librarian!”

[laughter]

Question 19. [1:05:40]

Paula: Well, let’s go back. Talking about what would be the best dates or times to conduct a project like ours? And the project would be, like, bringing in a select number of people who would then go through the family health history on the Surgeon General’s Website and actually map out their family health history. And it’s three generations: themselves, their parents, their grandparents. Then, it comes up, it gives them what’s called a pedigree – it’s like a dog, but anyway, once they have that pedigree it shows all the various health issues, or it may show no health issues, depending on how they completed the thing. There’s a lot of drop-down boxes that goes with it, and sometimes you really have to work with people to kind of get through it and you really want to be careful about their privacy, especially their health privacy.

But they do need help with the computer, and you do need a computer to do this, and once you’ve done that, you say, “okay, and is there anything on this particular chart that you want to look into a little bit further?” and if so, then that’s where we would bring in MedlinePlus, and then, from there, direct them to MedlinePlus.

Also what we would do is give them a flashdrive, to where, that they could save their own health history on a flashdrive. We would never see it, you would never see it, it doesn’t have to be printed off, they could email it to themselves or to a family member or something, or there’s a vault


that’s actually on the website. We suggest that they might want to take it home in a flashdrive, but then they could use that flashdrive for MedlinePlus as well, they could save that information to the flashdrive as well. So altogether, it would take, per person, it would take about two hours.

So if we wanted to do something like that, in your library setting, what day and time do you think would be best? And you’re [2] talking maybe Tuesdays.

2: Well, it depends, really, on your target audience. If you are looking for seniors, then a day when they could get free parking would be very important. But if you really, I mean, one thing that we have a lot of, because of Haven for Hope across the street, is that we have a big morning population of folks who are coming in from the shelters. They come in here in the mornings. So, any morning if that’s the target audience. But I don’t think either of those would really care much about a take-home flashdrive.

Paula: So, the other thing that we offer them is a twenty-dollar gift card, to HEB.

2: That would speak a lot to them, I think, both of those populations.

Paula: But what we want to do is promote to them, first of all, that they share it with their family. That’s one thing. But then they would take this, the pedigree, over to their – along with any other kinds of questions – over to their primary care doctor. So it may be that the evening, or the geriatric crew, might be more, in that kind of a, an easier way of promoting that. Whereas, what I’m hearing from you guys is more, “make it a family kind of event.”

1: But even then, at [my library], I don’t know how it is at [other library], our weekend programs have not been very successful. We’ve been more successful with weekday programs. We had a social media workshop on Monday in the early afternoon, and that had good turnout. We’ll have a family movie program on a Saturday and no one will come. Part of it’s how it’s promoted, obviously. The trend I’ve seen is, weekdays, we happen to be open late on Tuesdays and Thursdays and that’s when people might happen to be more available – after work.

4: If it would be on a weekday, it would be in the evening when we’re open late, probably on, also, we’re open late Tuesdays and Thursdays. Or, maybe a weekend, but it’s hard to really tell. A lot of times it’s hit and miss programming, we just don’t know if something’s going to work.

3: Yeah, especially since our calendar changed and flipped at this point. During the summer, during the weekdays would be great, because parents want something to do with their kids. Saturdays and Sundays they’re out with family or they’re, you know, on the beach, they’re somewhere else. But now that the school year has started, a lot of them might have a lot of after-school obligations. So, the weekday might not actually be the best at this point, because, miho’s got football practice and I’ve got another one who’s got homework to do and that sort of thing.

4: Two hours may be a big chunk of time for them to set aside.

[agreement]


3: And if we did promote it, maybe on a Saturday, possibly, but I would suggest that we have sort of a health fair type of thing for them, so that there’s more things for them to participate in other than just one particular, very good component of it. So you would have, maybe, the librarian create a come-and-go craft, or there’d be, maybe, a movie, or maybe some, I don’t know, Dr. Doolittle on the TV in the back and so while parents are focusing on this, kids have something to do as well. That might be a way to approach it.

Paula: Have you guys ever had a health fair there, or an assessment there at your library?

1: Well, what [1’s] just mentioned just sort of sparked an idea, because we just recently had a back-to-school fair and right across the street is CentroMed and I saw the councilmen, and it was packed: people were there from like five in the morning, and they waited in line to get free backpacks, they could even get a haircut. But they also get a lot of medical checkups, too. If we could somehow incorporate ourselves into something larger like that, where it’s just one part of the overall experience, then I could see that being effective. And that happens on a weekend.

4: I think that’s a good idea, you know, as part of a bigger program.

Paula: You could really randomize it.

Question 20. [1:12:57]

Paula: Okay, so, what do you find are effective ways to evaluate the success or not-so-successful parts of your program? I didn’t want to say the word “failure.”

[laughter]

3: Well, I wasn’t there for Sunday’s program, but they were showing the movie “The Cure” and it was an HIV-testing based program, and individuals were able to have the test while they were there. And our branch coordinator had the surveys, “tell us what you think.” He distributed them at the end of the event and picked them up, so he could see if he was successful in the feedback that he got. He hasn’t provided me with that feedback just yet, since it was on Sunday, but he said that seventeen individuals came in for the film, and they weren’t too happy about the number there, but ten individuals decided to have HIV testing while they were there and they felt that was very successful.

2: Yeah, you have to define your outcomes. Is the outcome a high attendance or is the outcome that people leave wanting to get tested?

3: Do they have a meaningful experience while they’re there?

Paula: How is the success measured?

2: We, I think, with children’s programming and teen programming, we really do have our outcomes built very well. With adult programming it’s not as well defined. You know, a lot of times you think the only outcome is big attendance, or bringing in people who aren’t regulars, but there are other outcomes, and defining what those other outcomes are will help evaluate success. Because, yeah,


seventeen, for a movie? I’d be like, well, that’s okay, but when the outcome is to educate people and ten of them leave, getting that message, then that’s very successful.

1: Yeah, I agree. Actually, if I got seventeen people for a movie at [my library] I’d be ecstatic. And it depends on the program, too, I mean, if it’s something educational, I think if you can say that they learned something out of it [trails off.] But what I’m always curious to learn about with programs is how they learned about it, so that I can use that for future marketing.

Paula [to 3]: Did you ask that question on your survey sheet?

3: I can’t remember all the questions that were asked. More than likely.

2: I think it does. If it’s the one that [your branch coordinator] made, then yeah, I think it does.

3: I’m curious to see about this. What the feedback will be.

1: I’m curious, too, I’ve seen the form but whether it asks very generally, does it say “media, internet?” I like, specifically, to know. Say, if everybody was at this picnic, then I’m going to look at, I’m going to target this picnic.

2: Over the holidays every year, I help with a big push for e-reader training. Our biggest, I think like sixty-six percent of people who came in, and it was hundreds, because I went to almost every branch in town, showing the newspaper. But the average age of people attending e-reading seminars is a little higher as well.

[laughter]

1: They read the newspaper.

[laughter]

2: A Venn diagram of people who read newspapers and people who need e-reader seminars, it has a lot of overlap.

3: But yeah, you’re right, I remember the app.

[laughter]

Questions 21 &22 [1:16:48]

Paula: Anything else that you want to bring up about anything that we’ve talked about today? It goes back to the question about, anything that has now triggered your thought or something like that. That you feel like you want to share with us.

4: I just agree that libraries can be great places for patrons to come and get health information and that I think we can do more; by having more programming, more training of staff, and I think that would


definitely be valuable to the library, and the community, and the health community. Everybody is going to gain by it.

Paula: One thing that I want to ask is; do you feel like you have good administrative support to develop these kinds of initiatives, so if that’s something that you want to do and you feel like it, you’ve got it. It’s one of those things where you want to make sure that what we’re thinking about doing, you feel comfort in that it’s not only me and your mission, personally, as a professional, but also that there’s an administrative, ah, to whatever we discover. And good research basically begs more research, quite frankly, because you get more questions out of what you did. Do you feel like you’ve got good administrative support that would move this along, knowing that we always understand that it can’t cost an arm and a leg, and it can’t take up more time than you’ve got to put together. Anything you want to share with that?

1: I mean, they’re aware of this and they were CC’d on the thing, and I’ve spoken to them about it and they seemed very eager and excited about it and you’ve spoken to them directly.

4: I think the library is always looking for a good program, ones that positively reflect on the library, and the community sees as valuable, and if the council sees it as valuable, even better, and the government part of it. I think, whenever we have that sort of program, the administration is a hundred percent behind it. I think in this case it falls into, kind of, covers all the bases.

2: Up there it asks, “what are your concerns with this project?” I’m not sure if that’s the question you’re asking, but when you’re talking about using it as a basis for research I think you always want to make that the by-product and not the main focus, because there is a worry about privacy in the library. But making the focus health literacy, and family health histories, is a much better framework of thinking about it.

1: Yeah, I definitely think that some people – many people, myself included – would be sensitive to just being seen as being a guinea pig.

Paula: And that’s not what we want. Well, thank you very much, I so appreciate everything: your time, your candor your thoughts. I’ve seen your names on paper so many times that now it’s good to see real folks. So, I appreciate that. So, our next step is; we will transcribe all of this and put it in a document. We’ll send it out to you, want you to see it and take a look at it and if you want to take a look at it.

family health history focus group transcription

Health & Medicine